Wiki DME Modifiers needed for L1845

[634sg4fs65g4fg]

I am trying to collect any information about needed modifiers when billing L1845? I am in Pain billing for a billing company and just learning these codes. Thank you Gail

 

[Orellana]

Hi, first Make sure the POS is Patient Home. Then use the appropiate modifiers accordinly.

• NU (New Equipment) crutches, canes, walkers, pulley systems, arch supports, hip abduction
  pillows, arm elevator pillows
• GY non-covered items
• RRKH for E0218 products
• Back braces, cervical collars and rib belts do NOT have a modifier
• RT/LT (Right or Left) for all other products, including non-covered items
• KX Required for knee and ankle-foot orthoses to affirm that medical necessity coverage criteria has been met and supporting documentation is on file

Happy Friday!!

 

[634sg4fs65g4fg]

Thank you!

 

[mswalker]

The above is correct for Medicare. Many private/commercial payers do not require a KX. Check the insurance payers medical policy.

 

[Miranda Nelson]

I work exclusively with Medicare DME. The LCD is key in billing knee braces. L1845 and L1832 have a VERY high denial rate. If the patient has Medicare, you will need to code it as L1845-KX-RT or LT. Be sure to review the LCD to make sure that it meets medical necessity. Also feel free to reach out to me if you need assistance with any other Medicare DME items